Transcatheter closure of patent ductus arteriosus, evaluating the outcome: Single center experience in Mansoura, Egypt

Abstract

Device closure is considered the treatment of choice for patent ductus arteriosus (PDA). The study presents our experience in transcatheter occlusion of PDA using three different devices between January 2008 and December 2016. The immediate and short-term outcome of 213 pediatric patients with PDA underwent PDA occlusion were analyzed. Aortic angiography was done to evaluate the size, position, and shape of the duct for proper device selection. A second aortic angiography was performed 10 min after device deployment. Echocardiography was repeated at intervals of 24 h, then at one, three, six and 12 months after the procedure to assess the presence of any complications. The mean age of patients was 9.2 ± 5.2 months and their mean weight was 7.6 ± 1.8 kg. Mean PDA diameter at its narrowest point measured by angiography was 2.81 ± 0.51 mm. Nit-Occlud pfm Coil occlusion was performed in 107 (50.2%) patients, Amplatzer ductal occluder was performed in 84 (39.4%) and Nit-Occlud PDA-R was performed in 22 (10.3%). Complete closure was observed in 95.7% of patients prior to discharge and this rate has reached 98.5% after three months of follow up and increased to 100% at 6 and 12-months visits. There was no significant difference regarding the outcome for each of the three devices prior to discharge and at 3 months follow up (p = 0.9974 and 0.9729, respectively). Limited complications were reported (e.g. aortic protrusion, mild LPA obstruction, significant blood loss) which were related mainly to the use of large devices (e.g. ADO-1) deployed over large diameter sheaths in young children with small body weight. In conclusion, percutaneous transcatheter closure of PDA technique using Nit-Occlud pfm coils, Amplatzer ductal occluder and Nit-Occlud PDA-R is proved to be safe and effective, with limited complications and non-significant hemodynamic consequences.